Shock Wave Catheter with Shock Absorber

This application is a divisional of U.S. patent application Ser. No. 18/524,660, filed Nov. 30, 2023, the disclosure of which is incorporated herein by reference in its entirety.

The present disclosure relates generally to the field of medical devices and methods, and more specifically to acoustic pressure wave generating assemblies for inclusion in catheter devices used for treating lesions in a body lumen, such as calcified lesions and occlusions in vasculature.

A wide variety of catheters have been developed for treating calcified lesions, such as calcified lesions in vasculature associated with arterial disease. For example, treatment systems for percutaneous coronary angioplasty or peripheral angioplasty use angioplasty balloons to dilate a calcified lesion and restore normal blood flow in a vessel. In these types of procedures, a catheter carrying a balloon is advanced into the vasculature along a guide wire until the balloon is aligned with calcified plaques. The balloon is then pressurized (normally to greater than 10 atm), causing the balloon to expand in a vessel to push calcified plaques back into the vessel wall and dilate occluded regions of vasculature.

More recently, the technique and treatment of intravascular lithotripsy (IVL) has been developed, which is an interventional procedure to modify calcified plaque in diseased arteries. The mechanism of plaque modification is through use of a catheter having one or more acoustic shock wave generating sources located within a fluid that can generate acoustic shock waves that modify the calcified plaque. IVL devices vary in design with respect to the energy source used to generate the acoustic shock waves, with two exemplary energy sources being electrohydraulic generation and laser generation.

For electrohydraulic generation of acoustic shock waves, a conductive solution (e.g., saline) may be contained within an enclosure that surrounds electrodes or can be flushed through a tube that surrounds the electrodes. The calcified plaque modification is achieved by creating acoustic shock waves within the catheter by an electrical discharge across the electrodes. The energy from this electrical discharge enters the surrounding fluid faster than the speed of sound, generating an acoustic shock wave. In addition, the energy creates one or more rapidly expanding and collapsing vapor bubbles that generate secondary shock waves. The shock waves propagate radially outward and modify calcified plaque within the blood vessels. For laser generation of acoustic shock waves, a laser pulse is transmitted into and absorbed by a fluid within the catheter. This absorption process rapidly heats and vaporizes the fluid, thereby generating the rapidly expanding and collapsing vapor bubble, as well as the acoustic shock waves that propagate outward and modify the calcified plaque. The acoustic shock wave intensity is higher if a fluid is chosen that exhibits strong absorption at the laser wavelength that is employed. These examples of IVL devices are not intended to be a comprehensive list of potential energy sources to create IVL shock waves. Other energy sources are possible to create IVL shock waves, including piezoelectric sources.

The IVL process may be considered different from standard atherectomy procedures in that it cracks calcium but does not liberate the cracked calcium from the tissue. Hence, generally speaking, IVL should not require aspiration nor embolic protection. Further, due to the compliance of a normal blood vessel and non-calcified plaque, the shock waves produced by IVL do not modify the normal vessel tissue or non-calcified plaque. Moreover, IVL does not carry the same degree of risk of perforation, dissection, or other damage to vasculature as atherectomy procedures or angioplasty procedures using cutting or scoring balloons.

More specifically, catheters to deliver IVL therapy have been developed that include pairs of electrodes for electrohydraulically generating shock waves inside an angioplasty balloon. Shock wave devices can be particularly effective for treating calcified plaque lesions because the acoustic pressure from the shock waves can crack and disrupt lesions near the angioplasty balloon without harming the surrounding tissue. In these devices, a catheter is advanced over a guidewire through a patient's vasculature until it is positioned proximal to and/or aligned with a calcified lesion in a body lumen. The balloon is then inflated with a fluid so that the balloon expands (e.g., to a relatively low pressure of 2-4 atm) to contact the lesion but is not inflated to a pressure that substantively displaces the lesion. Voltage pulses can then be supplied to the emitters (e.g., by applying a voltage across one or more electrode pairs of an emitter) to produce acoustic shock waves that propagate through the walls of the angioplasty balloon and into the lesions. Once the lesions have been cracked by the acoustic shock waves, the balloon can be expanded further to increase the cross-sectional area of the lumen and improve blood flow through the lumen. Alternative devices to deliver IVL therapy can be within a closed volume other than an angioplasty balloon, such as a cap, balloons of various compliances, or other enclosures.

Efforts have been made to improve the design of electrode assemblies included in shock wave and directed cavitation catheters. For instance, low-profile electrode assemblies have been developed that reduce the crossing profile of a catheter and allow the catheter to more easily navigate calcified vessels to deliver shock waves in more severely occluded regions of vasculature. Examples of low-profile electrode designs can be found in U.S. Pat. Nos. 8,888,788, 9,433,428, and 10,709,462, and in U.S. Publication No. 2021/0085383 all of which are incorporated herein by reference. Other catheter designs have improved the delivery of shock waves, for instance, by specific electrode construction and configuration thereby directing shock waves in a forward direction to break up tighter and harder-to-cross occlusions in vasculature. Examples of forward-firing catheter designs can be found in U.S. Pat. Nos. 10,966,737, 11,478,261, and 11,596,423 and U.S. Publication Nos. 2023/0107690 and 2023/0165598, all of which are incorporated herein by reference.

For treating aortic valve stenosis and other larger body lumens, conventional IVL devices may not be as effective. Previous efforts to implement IVL for treating aortic valves have employed, for example, multiple IVL balloons, as described in U.S. Pat. No. 9,554,815, which is incorporated herein by reference. The sonic output from a radially propagating shock wave emitter decays with distance; thus, for treating aortic valve stenosis or larger vessels (e.g., carotid arteries, iliac arteries) with a conventional IVL device, a relatively higher sonic output may be required for shock wave generating emitters to effectively modify calcified lesions. Alternatively, a relatively higher number of shock wave pulses may be used to treat a calcified lesion in a larger vessel than in a smaller vessel. Physicians face a similar problem when treating eccentric calcified lesions (i.e., lesions where calcium buildup is predominantly along one side of the vessel). When an IVL balloon is inflated in such cases, shock wave emitters may be pushed farther away from the eccentric lesion to be treated.

However, increasing the sonic output from a shock wave emitter may lead to degradation of the emitter and faster failure of the device. One reason for this failure is that increasing the sonic output amplifies the pressures exerted on various structural aspects of the device (e.g., seals, insulating layers, etc.). In particular, past IVL emitters have included polyimide or similar materials with high breakdown voltage as an electrically insulating material. Polyimide may be favored for intravascular applications, because it can be made very thin, which is useful for decreasing the overall profile of the IVL catheter and has been shown to be an effective material for use in conventional IVL therapy. Polyimide may also be favored for its high heat resistance (e.g., greater than 250 degrees Celsius). But to meet (a) the durability requirements of IVL catheters with higher sonic output (e.g., to withstand the increased amounts of plasma, pressure, and heat produced during higher pressure shock wave generation) and (b) the longevity requirements of increasing the number of shock wave pulses, improvements to conventional IVL catheters are required.

According to an aspect of the disclosure, an intravascular lithotripsy (IVL) catheter may include a shock wave generating region that includes a conductive wire, an inner tube, a shock absorber, and an outer band. The inner tube and the outer band may be electrically configured to form an electrode pair where applying a voltage across the electrode pair leads to the generation of a shock wave.

According to an aspect of the disclosure, an IVL catheter may include a shock wave generating region that includes a conductive wire, a shock absorber, and an outer band. A distal end of the conductive wire and the outer band may be electrically configured to form an electrode pair where applying a voltage across the pair leads to the generation of a shock wave.

According to an aspect of the disclosure, an IVL catheter may include a shock wave generating region that includes a conductive wire, an inner tube, an outer band, and an encasing adhesive, where the inner tube and the outer band form an electrode pair. The encasing adhesive may be made of a material chosen to withstand the pressure, plasma, and/or heat generated when a high voltage (e.g., greater than 6 kV) is applied across the electrode pair.

In any of these examples, a catheter for treating lesions in a body lumen may include an elongate member and at least one shock wave emitter assembly mounted over a distal portion of the elongate member. The shock wave emitter assembly may include an electrode pair including an inner electrode and an outer electrode and may be configured to generate a shock wave when a voltage is applied across the electrode pair. The catheter may further include a shock absorber located at least partially between the inner electrode and the outer electrode and surrounding the inner electrode. The shock absorber may have an aperture aligned with the inner electrode and may include a polymer material having a Shore A hardness value no greater than 100. In any of these examples, the polymer material may be a thermoplastic polyurethane. In any of these, the polymer material may have a Shore A hardness value no less than 50. In any of these examples, the polymer material may have a Shore A hardness value no greater than 90. In any of these examples, the catheter may include an enclosure that at least partially surrounds the shock wave emitter assembly, wherein shock waves are transmitted through a wall of the enclosure. In any of these examples, the enclosure may include a balloon (e.g., an angioplasty balloon). In any of these examples, the polymer material may be an electrically insulating material. In any of these examples, the at least one shock wave assembly may be electrically connected to a power supply configured to generate a generator voltage no less than 6 kV.

In any of these examples, a catheter system for treating lesions in a body lumen may include a catheter and a power supply. The catheter may include an elongate member, at least one shock wave emitter assembly mounted over a distal portion of the elongate member, the shock wave emitter assembly including an inner electrode, a shock absorber at least partially surrounding the inner electrode and having a shock absorber aperture aligned with the inner electrode, and a conductive band comprising an outer electrode that is aligned with the shock absorber aperture, the inner electrode and the outer electrode forming an electrode pair. The power supply may be electrically connected to the at least one shock wave emitter assembly and may be configured to supply a voltage no less than 6 kV to the shock wave emitter assembly. In any of these examples, the shock absorber includes a polymer material. In any of these examples, the shock absorber may include a thermoplastic polyurethane. In any of these examples, the polymer material may have a Shore A hardness value no less than 50. In any of these examples, the polymer material may have a Shore A hardness value no greater than 90. In any of these examples, the polymer material may be an electrically insulating polymer material. In any of these examples, the catheter may include an enclosure that at least partially surrounds the shock wave emitter assembly and shock waves are transmitted through a wall of the enclosure. In any of these examples, the enclosure may include a balloon (e.g., an angioplasty balloon). In any of these examples, the power supply may be configured to generate a generator voltage no less than 10 kV. In any of these examples, the shock absorber may have a thickness no less than 0.25 mm and no greater than 1.0 mm.

In any of these examples, a catheter system for treating lesions in a body lumen may include catheter and a power source. The catheter may include a distal region with a shock wave generating region and a shock absorber located at the distal region and contacting the shock wave generating region. The power source may provide energy to the shock wave generating region. The shock absorber may include a thermoplastic polyurethane. In any of these examples, the thermoplastic polyurethane may have a Shore A hardness value no greater than 90. In any of these examples, the thermoplastic polyurethan may have a Shore A hardness value no less than 50. In any of these examples, the catheter may further include an enclosure sealed to the distal region and surrounding and separated from the shock wave generating region.

In any of these examples, a catheter for treating lesions in a body lumen may include an elongate member and at least one shock wave emitter assembly located at a distal portion of the elongate member. The shock wave emitter assembly may include an electrode pair that has a first electrode electrically connected to a high voltage power source and a second electrode spaced apart from the first electrode and electrically connected to the high voltage power source. The shock wave emitter assembly may be configured to generate a shock wave when a voltage is applied across the electrode pair. The shock wave emitter assembly may include a shock absorber at least partially located between the first electrode and the second electrode. The shock absorber may include a polymer material having a Shore A hardness value no greater than 100 and the first electrode may include an edge of a conductive sheath.

In any of these examples, a catheter for treating lesions in a body lumen may include an elongate member and a plurality of axially aligned shock wave emitter assemblies located at a distal portion of the elongate member. Each of the shock wave emitter assemblies may include an electrode pair having a first electrode electrically connected to a high voltage power source and a second electrode spaced apart from the first electrode and electrically connected to the high voltage power source. The shock wave emitter assembly may be configured to generate a shock wave when a voltage is applied across the electrode pair. Each shock wave emitter assembly may further include a shock absorber at least partially located between the first electrode and the second electrode. The shock absorber may include a polymer material having a Shore A hardness value no greater than 100.

In any of these examples, a method of treating a lesion in a body lumen may include: positioning a catheter adjacent to the lesion, the catheter including an emitter assembly with at least one shock wave generating region having a shock absorber made at least in part of a material having a Shore A hardness no greater than 100; and applying a high voltage pulse of no less than 6 kV to the emitter assembly. In any of these examples, the shock absorber may be made of a material having a Shore A hardness no greater than 90. In any of these examples, the high voltage pulse may be no less than 10 kV. The shock absorber material may be a thermoplastic polyurethane. The shock absorber material may be an electrically insulating material. The catheter may further include an enclosure and the method may include the step of inflating the enclosure to a pressure no more than 5 atm.

In any of these examples, a method of treating a lesion in a body lumen may include (a) positioning a catheter adjacent to the lesion, the catheter having an emitter assembly including at least one shock wave generating region comprising a shock absorber made at least in part of a material having a Shore A hardness no greater than 100 and an enclosure surrounding the emitter assembly; (b) filling the enclosure with a fluid; and (c) generating a shock wave by applying a high energy pulse to the emitter assembly, wherein the shock wave exerts no less than 50 atm of pressure to the lesion. The shock absorber material may be a thermoplastic polyurethane. The shock absorber material may be an electrically insulating material. The step of filling the enclosure with fluid may include filling the enclosure with fluid to a pressure no more than 5 atm.

Any of the exemplary systems above can be used with any of the example catheters above. Additionally, any of the example catheters and systems above can be used for performing any of the methods above. Accordingly, any of the systems, catheters, and methods described above may be combined, in whole or in part, with one another and/or with any other features or characteristics described elsewhere herein.

The following description is presented to enable a person of ordinary skill in the art to make and use the various embodiments and aspects thereof disclosed herein. Descriptions of specific devices, assemblies, techniques, and applications are provided only as examples. Various modifications to the examples described herein will be readily apparent to those of ordinary skill in the art, and the general principles described herein may be applied to other examples and applications without departing from the spirit and scope of the various embodiments and aspects thereof. Thus, the various embodiments and aspects thereof are not intended to be limited to the examples described herein and shown but are to be accorded the scope consistent with the claims.

As provided herein, it should be appreciated that any disclosure of a numerical range describing dimensions or measurements such as thicknesses, length, weight, time, frequency, temperature, voltage, current, angle, etc. is inclusive of any numerical increment or gradient within the ranges set forth relative to the given dimension or measurement. Furthermore, numerical designators such as “first,” “second,” “third,” “fourth,” etc. are merely descriptive and do not indicate a relative order, location, or identity of elements or features described by the designators. For instance, a “first” shock wave may be immediately succeeded by a “third” shock wave, which is then succeeded by a “second” shock wave. As another example, a “third” emitter may be used to generate a “first” shock wave and vice versa. Accordingly, numerical designators of various elements and features are not intended to limit the disclosure and may be modified and interchanged.

In the following description of the various embodiments, reference is made to the accompanying drawings, in which are shown, by way of illustration, specific embodiments that can be practiced. It is to be understood that other embodiments and examples can be practiced, and changes can be made without departing from the scope of the disclosure.

In addition, it is also to be understood that the singular forms “a,” “an,” and “the” used in the following description are intended to include the plural forms as well, unless the context clearly indicates otherwise. It is also to be understood that the term “and/or” as used herein refers to and encompasses any and all possible combinations of one or more of the associated listed items. It is further to be understood that the terms “includes, “including,” “comprises,” and/or “comprising,” when used herein, specify the presence of stated features, integers, steps, operations, elements, components, and/or units, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, units, and/or groups thereof.

The present disclosure relates generally to a catheter system for treating stenosis of the aortic valve and lesions in other body lumens. The catheter system may include one or more shock wave generating regions that emit shock waves and/or cavitation bubbles for cracking lesions (e.g., calcified, fibrotic, or thrombic lesions). As described in more detail below, the catheter system may include a shock absorber that is made of a low durometer material. The addition of a shock absorber makes the catheter system more durable and capable of generating and withstanding shock waves with high sonic output. The shock absorber may also be used to increase the longevity of the shock wave generating region and, thus, the catheter itself. The catheter system may also include a relatively low durometer adhesive.

IVL catheter systems generate plasma, heat, and pressure every time the system applies therapy, i.e., when a cavitation bubble is formed and/or a shock wave is generated. At some operating parameters, the energies that are used to apply therapy may result in levels of generated plasma, heat, and pressure that can quickly degrade or displace the structures (e.g., electrohydraulic electrode assemblies) which are used to generate the shock wave for IVL. The shock absorber in part improves the durability and longevity of the catheter system by distributing or redirecting pressure that would otherwise impact, degrade, or displace the shock wave generating structures or other parts of the catheter. In this regard, the shock absorber operates as a structural pressure dampener or structural stabilizer to the shock wave generating structures (e.g., the emitter assemblies described in more detail below). In other words, incorporating a shock absorber in a shock wave generating structure dampens or reduces the amount of pressure that reaches and impacts the shock wave generating structures. However, the term “shock absorber” is not intended to imply that these structural features dampens or lessens sonic output from the device (i.e., the pressure exerted during treatment). Moreover, the selection of the material of the shock absorber may also be heat resistant, mitigating degradation from heat generated during the application of therapy.

1 FIG. 1 FIG. 100 172 100 170 100 110 100 160 120 100 101 102 103 104 105 100 170 101 102 103 104 105 100 illustrates an exemplary IVL catheter system according to one or more aspects of the disclosure. The catheter system includes a catheter, an energy guidefor routing energy to the catheter, and a power source. The catheterincludes a central tubehaving a guide wire lumen for guiding the catheteralong a guide wireto the treatment site and an enclosure. The catheterincludes shock wave generating regions,,,, andthat are located along the central tube. In response to delivery of energy from the power source, one or more shock waves are generated from one or more of the shock wave generating regions,,,, and. The cathetermay be configured to selectively emit shock waves from one or more of the shock wave generating regions, in alternating sequence or at the same time. Although five shock wave generating regions are shown in, fewer shock wave generating regions (e.g., one, two, three, or four shock wave generating regions) may be included in shorter catheters for treating shorter lesions or more shock wave generating regions may be included in longer catheters for treating longer lesions.

1 FIG. Exemplary IVL catheter systems (such as the one shown in) are used for treating lesions in body lumens. In various examples, a lesion could be a calcified region of vasculature, a thrombus or an occlusion in vasculature, arteriosclerotic plaque, or a lesion in some other body lumen, such as a kidney stone in a ureter.

101 102 103 104 105 In one or more embodiments, each of the one or more of the shock wave generating regions,,,, andincludes an electrode assembly, which includes one or more electrode pairs. As used herein, the term “electrode” refers to an electrically conducting element (typically made of metal) that receives electrical current and subsequently releases the electrical current to another electrically conducting element. In the context of the present disclosure, electrodes are often positioned relative to each other, such as in an arrangement of an inner electrode and an outer electrode. Accordingly, as used herein, the term “electrode pair” refers to two electrodes that are positioned adjacent to and spaced apart each other such that application of a sufficiently high voltage to the electrode pair will cause an electrical current to transmit across the gap (also referred to as a “spark gap”) between the two electrodes (e.g., from an inner electrode to an outer electrode, or vice versa, optionally with the electricity passing through a conductive fluid or gas therebetween). In some contexts, one or more electrode pairs may also be referred to as an electrode assembly. In the context of the present disclosure, the term “emitter” broadly refers to the area of an electrode assembly where the current transmits across the electrode pair, generating a shock wave. The terms “emitter sheath” and “emitter band” refers to a continuous or discontinuous band of conductive material that may form one or more electrodes of one or more electrode pairs, thereby forming a location of one or more emitters.

101 102 103 104 105 The shock wave generating regions,,,, andadditionally or alternatively may comprise a laser and optical fibers as a shock wave emitter system whereby the laser source delivers energy through an optical fiber and into a fluid to form shock waves and/or cavitation bubbles. Accordingly, although some shock wave devices described herein generate shock waves based on high voltage pulses applied to electrodes, it should be understood that a shock wave device may additionally or alternatively use laser pulses transmitted through optical fibers to generate shock waves and that the “emitters”, “electrodes”, and “electrode pairs” described herein may instead include output ends of optical fibers. These examples are not intended to be a comprehensive list of potential power sources to create shock waves in shock wave catheters.

170 170 170 170 170 170 1 FIG. In one or more embodiments of the present disclosure, the power sourceshown inincludes a high voltage pulse generator. In one or more embodiments, the power sourcesupplies a high voltage pulse no less than six kilovolts (6 kV). In one or more embodiments, the power sourcesupplies a high voltage pulse no less than ten kilovolts (10 kV). In one or more embodiments, the power sourcesupplies a high voltage pulse between three kilovolts (3 kV) and twenty kilovolts (20 kV). In one or more embodiments, the power sourcesupplies a high voltage pulse between six kilovolts (6 kV) and ten kilovolts (10 kV). In one or embodiments, the power sourceis configured to supply a high voltage pulse that is adjustable in intensity. As explained above, the application of a relatively high voltage pulse (e.g., greater than 6 kV) may be beneficial for treating certain types of lesions (e.g., lesions associated with aortic valve stenosis) that necessitate a higher sonic output for treatment.

120 120 120 101 102 103 104 105 120 1 FIG. The enclosureshown in, in one or more embodiments, is a balloon (e.g., an angioplasty balloon). The enclosuremay be in a collapsed or deflated configuration to provide a lower profile during delivery to the treatment site. During treatment, the enclosureis inflated to a pressure between two and four atmospheres (2 atm-4 atm) with a liquid fluid (e.g., saline). Energy is then provided to shock wave generating regions,,,, andresulting in the generation of one or more shock waves. The enclosure may then be deflated and reinflated to flush out any accumulated gas bubbles before further treatment at that site. The enclosuremay alternatively be advanced further to a different lesion (or different section of the same lesion) or withdrawn from the patient.

101 102 103 104 105 200 210 242 220 230 220 222 230 232 222 230 242 200 2 FIG. One or more of the shock wave generating regions,,,, andmay include an electrode assembly.illustrates an exemplary electrode assemblythat includes a central tube, an inner electrode, a shock absorber, an outer electrode. The shock absorber, which is made of an electrically insulating material, includes an aperture. The outer electrodeincludes an aperturethat is aligned with the aperture. The outer electrodeand the inner electrodeform an electrode pair that, when a high voltage is applied across the electrode pair (i.e., through the aligned apertures), generates a shock wave that propagates away from the central tube. A second inner electrode and aligned apertures may be located on a circumferentially opposite side of the electrode assembly.

220 In various embodiments of the present disclosure, a catheter for use in intravascular lithotripsy (IVL) includes a shock absorber such as the shock absorber. As noted above, the term “shock absorber” is used to describe a structural feature of an IVL catheter that can effectively reduce any destructive impact of acoustic pressure waves (e.g., shock waves) to a shock wave generating region of the catheter.

In various embodiments, a shock absorber is made of a material that has a Shore A hardness less than 100. In one or more embodiments, a shock absorber is made of a material that has a Shore A hardness less than 90. In one or more embodiments, a shock absorber is made of a material that has a Shore A hardness less than 75. In some embodiments, a shock absorber is made of a material that has a Shore A hardness no less than 20. Herein, material hardness is in accordance with ISO 48-4:2018. Such relatively softer materials have an acoustic impedance that is better suited to withstand the high pressures associated with shock waves when compared to relatively harder materials such as polyimide.

In some embodiments, a shock absorber (e.g., a shock absorbing layer) for a shock wave catheter is made of a material that has a flexural modulus less than 1 GPa. In some embodiments, the flexural modulus is no greater than 0.25 GPa. In other embodiments, the flexural modulus is no greater than 50 MPa. Herein, flexural modulus of a material is determined in accordance with ISO 178:2019.

In one or more embodiments, a shock absorber is made of an elastomeric material. An elastomeric material can include various thermoplastic polyurethanes (TPUs), rubbers, silicones, fluoropolymers (e.g., polytetrafluoroethylene), or other materials having similar elastomeric properties. In particular, TPUs may be effective for their versatility in manufacturing and relatively low cost when compared to materials such as polyimide. Further, including such elastomeric materials in an IVL catheter may improve its flexibility and thus navigability through body lumens.

As noted above, incorporating a shock absorber into a shock wave generating structure can greatly improve longevity (i.e., the number of shock wave pulses the structure can generate before failure due to deterioration) of the structure (and, thus, the device). For example, incorporating the shock absorber in place of higher durometer insulating material can increase the longevity of the shock wave generating structure ten-fold.

3 3 FIGS.A andB 3 FIG.A 3 FIG.B 320 330 320 320 320 330 200 330 330 illustrate an exemplary shock absorberoverlaid with an outer band, according to one or more aspects of the present disclosure.is a perspective view andis a cross sectional view through the shock absorberand outer band. The shock absorberand outer bandmay be part of an electrode assembly (such as electrode assembly), where the outer bandis an electrode of an electrode pair that is configured to generate shock waves. In this embodiment, the outer bandis, at least in part, formed of an electrically conductive material (e.g., stainless steel, nickel, molybdenum, platinum, palladium, tungsten, iridium, copper, or alloys thereof).

320 320 In other embodiments, the shock absorberis provided as a structural feature of a light energy (e.g., lasers) generated shock wave generating region. In such applications, the shock absorbersimilarly improves durability of the shock wave generating region.

3 FIG.B 320 330 320 320 320 As shown in, the shock absorber, in one or more embodiments, is thicker than the outer band. In one or more embodiments, the shock absorberis 0.25 mm to 1.0 mm in thickness. In one or more embodiments, the shock absorberis 0.3 mm to 0.6 mm in thickness. In other embodiments, the shock absorberis no less than 0.5 mm in thickness.

320 330 320 330 320 330 330 330 320 330 320 In one or more embodiments, the shock absorberis slightly compressed by outer band. The shock absorberincludes a shock absorbing layer that is at least partially surrounded by outer band. The outer diameter of the shock absorberis 2.0 mm to 4.0 mm and the outer diameter of the outer bandis less than the outer diameter of the shock absorber, in one or more embodiments of the disclosure. In other embodiments, the shock absorber outer diameter is 3.0 mm to 4.0 mm. and the outer diameter of the outer bandis no greater than 3.0 mm. When the outer bandcompresses the shock absorber, the outer bandcan be better secured to the shock absorber, further improving the structural integrity of the assembly.

320 324 326 320 324 326 330 320 In one or more embodiments, shock absorberhas a distal portionand a proximal portion. The overall length (from the proximal end to the distal end) of the shock absorberis 2.0 mm to 10 mm and the proximal portionand the distal portionare each about 0.5 mm to about 3.0 mm in length. The outer bandhas a length of 0.5 mm to 3.0 mm. In one or more embodiments, the overall length of shock absorberis no less than 3.0 mm and the outer band has a length no more than 2.0 mm.

330 332 332 334 336 330 330 320 330 330 320 330 a b The outer bandincludes aperturesand, notchesand tabs. These features can help to secure outer bandmore tightly to the shock absorberwhen the outer bandslightly compresses the shock absorber. In embodiments where the outer bandis an electrode, these features may also provide edge surfaces where a spark gap is formed. In such embodiments, the shock absorberincludes aligned cutouts as openings between an inner electrode (not shown) and the outer band.

320 320 330 3 3 FIGS.A andB It should be understood that while shock absorberis depicted inas being cylindrical in shape, other geometries are possible, including discontinuous sheaths and patches. Shock absorbercan additionally be formed with various apertures and cutouts (e.g., to provide gaps for current to pass from inner and outer electrodes). Similarly, the outer bandneed not be a continuous band. For the sake of clarity in these figures, no interior lumen (e.g., a guide wire lumen, fluid lumen, or other lumens) or interior electrode surface are shown. However, it should be appreciated that the shock absorber is positioned at least in part between the outer lumen and either or both of an interior lumen and inner electrode surface.

4 4 FIGS.A-C 4 FIG.A 4 FIG.B 4 FIG.C 4 FIG.B 1 FIG. 400 4 400 440 430 440 430 420 440 430 412 414 170 430 440 412 414 412 414 432 442 432 422 illustrate a distal end of an exemplary electrode assemblyof a catheter designed to generate and direct shock waves and/or cavitation bubbles in a distal direction of the catheter according to one or more embodiments of the present disclosure.is a perspective view,is a distal end view, andis a side cross-sectional view through planeC in. The assemblyincludes an inner conductive sheathand an outer conductive sheath. The inner and outer conductive sheathsandare separated by a shock absorberto provide an electrically insulating layer that can effectively withstand the high pressures associated with generating shock waves and cavitation bubbles. The inner conductive sheathand the outer conductive sheathrespectively form inner and outer electrodes of an electrode pair. Wiresand, which extend from a high voltage power source (such as the power supplyin) along the length of the catheter, are electrically connected to the outer conductive sheathand the inner conductive sheath, respectively. One of the wiresandis connected to a negative terminal of the high voltage source and the other wire is connected to a positive terminal of the high voltage source. When a high voltage pulse is applied to the wiresand, current flows across a spark gap between the outer conductive sheath distal edgeand the inner conductive sheath distal edge, resulting in a shock wave and/or cavitation bubble. The outer conductive sheath distal edgemay be positioned at the same distal location as a shock absorber distal edge.

420 420 420 400 The dielectric properties and thickness of the shock absorberallow for the shock absorberto erode in a controlled manner as successive high voltage pulses erode parts of the conductive sheath edges. Further, the acoustic impedance of the shock absorberis selected to better facilitate the transmission of acoustic pressure waves and improve the durability of the electrode assembly.

5 FIG. 1 FIG. 500 500 540 530 540 530 520 540 530 170 530 540 512 514 532 542 illustrates a distal end of another exemplary electrode assemblyof another catheter designed generate and direct shock waves or cavitation bubbles in a distal direction of the catheter according to one or more embodiments of the present disclosure. The assemblyincludes an inner conductive coiland an outer conductive sheath. The inner conductive coiland the outer conductive sheathare separated by a shock absorberto provide an electrically insulating layer that can effectively withstand the high pressures associated with generating shock waves and cavitation bubbles. The inner conductive coiland the outer conductive sheathrespectively form inner and outer electrodes of an electrode pair. Two wires extend from a high voltage power source (such as power supplyin) along the length of the catheter, are electrically connected to the outer conductive sheathand the inner conductive coil. One of the wires is connected to a negative terminal of the high voltage source and the other wire is connected to a positive terminal of the high voltage source. When a high voltage pulse is applied to the wiresand, current flows across a spark gap between the outer conductive sheath distal edgeand the inner conductive coil distal end, resulting in a shock wave and/or cavitation bubble.

In alternative implementations, shock absorber material can be placed between the turns of a conductive coil, in the gap or pitch of the coil. In such embodiments, the lumen between the conductive coil and the conductive sheath can be an electrically insulating layer or a further layer of shock absorber material.

520 520 520 532 542 5 FIG. Similar to the embodiments described above, the shock absorberfunctions to both insulate conductive components of the electrode assembly from each other and, importantly, to provide a medium through which acoustic waves may be effectively transmitted. In the embodiment shown in, the shock absorbermay also have a suitable breakdown voltage such that the shock absorbererodes upon application of a high voltage pulse across the electrode pair. As the electrode material also erodes at the site of the spark gap upon application of a high voltage pulse, an optimal spacing between the electrodes of the electrode pair (i.e., the distance between the outer conductive sheath edgeand the inner conductive coil distal end) may be maintained upon successive applications of a high voltage pulse.

In one or more embodiments, a shock wave catheter includes a low durometer adhesive. A low durometer adhesive may include an adhesive that (upon curing) has a Shore A hardness less than 100. In some examples, the low durometer adhesive has a Shore A hardness less than 50. The low durometer adhesive may be applied to adhere components of shock wave generating regions together. In one or more embodiments, a low durometer adhesive includes a cyanoacrylate (e.g., an ethyl and octyl cyanoacrylate). In one or more embodiments, a low durometer adhesive includes a silicone. For example, the low durometer adhesive may be applied to fix the positions of conductive bands or sheaths (such as those described above) to insulating layers or shock absorbers.

6 FIG. 6 FIG. 600 600 600 601 602 602 601 601 600 606 610 606 610 670 672 612 612 616 606 610 614 618 670 612 672 616 600 650 600 illustrates a distal region of catheterdesigned to generate and direct shock waves or cavitation bubbles in a distal direction of the catheteraccording to one or more embodiments of the present disclosure. In some embodiments, catheterincludes a catheter bodythat includes, at least in a distal region, a shock absorber. The shock absorbermay be included as an outer layer of the catheter bodyor may be integrally formed as part of the catheter bodyas shown in. Catheterincludes shock wave emitters-. Each of the shock wave emitters-can include a first electrode (e.g., conductive sheaths,) and a second electrode (e.g., insulated wires having conductive distal ends). The first and second electrodes form an electrode pair spaced apart by a spark gap. When voltage is applied across the electrode pair (e.g., by current delivered or carried away by wiresandto a power supply), a shock wave is generated. Shock wave emitters-may be connected to one or more of each other in series (e.g., by wires,) such that current is delivered from a power source to a first electrode pair (e.g., conductive sheathand exposed end of wire), then to a second electrode pair (e.g., conductive sheathand exposed end of insulated wire), and either back to the power source or a third electrode pair. Catheteradditionally includes a guidewire lumen, which can be used to deliver catheterto a treatment site.

600 606 610 602 600 606 610 Advantageously, the cathetercan be configured such that shock waves emitted from the shock wave emitters-constructively interfere and amplify the sonic output generated by the device. As such, the pressures generated by such a catheter having a plurality of distally directed shock wave emitters may be substantially higher than if only a single shock wave emitter was included. Shock absorbermay thus be important to increasing the durability and longevity of catheter, particularly at the region of the shock wave emitters-.

600 600 606 610 601 While catheteris shown with each shock wave emitter formed by a conductive sheath and an exposed end of an insulated wire, in other embodiments, each electrode pair of a shock wave emitter is formed by exposed ends of conductive wires. In some embodiments, catheterincludes a distal enclosure that defines a chamber housing one or more of the shock wave emitters-. In other embodiments, there is no enclosure, and the shock wave emitters emit shock waves directly within the body lumen. In such embodiments, catheter bodymay be provided with an additional aspiration lumen to remove debris generated by the shock wave treatment.

7 FIG. 701 702 701 702 illustrates a method of treating a lesion with a catheter having a shock absorber according to one or more aspects of the disclosure. The method includes, at step, navigating an IVL catheter and positioning it adjacent to a lesion (e.g., a calcified artery or heart valve). The IVL catheter includes a shock wave emitter assembly and a shock absorber similar to the embodiments described above. At step, one or more high voltage pulses no less than a minimum voltage are applied to the emitter assembly. The minimum voltage is no less than 6 kV. In some embodiments, the minimum voltage is no less than 10 kV. Application of the high voltage pulse results in the generation of one or more shock wave from the emitter assembly. Optionally, stepsandcan be repeated to treat a different region of the lesion or to treat a different lesion.

8 FIG. 801 802 803 801 803 illustrates another method of treating a lesion with a catheter having a shock absorber according to one or more aspects of the disclosure. At step, an IVL catheter is positioned adjacent to a lesion (e.g., a calcified artery or heart valve). The IVL catheter includes a shock absorber, an enclosure, and an emitter assembly. The shock absorber is made of a low durometer material as described above. The emitter assembly can include one or more electrode pairs for generating shock waves. In some embodiments, the emitter assembly includes one or more ends of optical fibers that deliver light energy for generating shock waves electromagnetically. At step, the enclosure is filled with a fluid. The fluid may be a conductive fluid such as saline. The fluid may include an x-ray imaging contrast agent such as iodinated contrast agents. In some embodiments, the enclosure is a balloon that is inflated to a pressure less than 5 atm. At step, one or more high energy pulses (e.g., a high voltage pulse no less than 10 kV) are applied to the emitter assembly. The emitter assembly generates one or more shock waves that exert no less than 50 atm of pressure to the lesion. Following shock wave treatment, the enclosure is deflated. In some examples, the enclosure may be refilled with fluid and the lesion may be treated with additional shock waves. Optionally, steps-are repeated at a different region of the lesion or to treat a different lesion.

In other embodiments, distally firing catheters include distally directed ends of light guides (e.g., optical fibers) and a shock absorber such as those described above. In such embodiments, the shock absorber helps stabilize the structure of the distal end of a catheter without dampening the acoustic output.

Although the electrode assemblies and catheter devices described herein have been discussed primarily in the context of treating coronary occlusions, such as lesions in vasculature, the electrode assemblies and catheters herein can be used for a variety of occlusions, such as occlusions in the peripheral vasculature (e.g., above-the-knee, below-the-knee, iliac, carotid, etc.). For further examples, similar designs may be used for treating soft tissues, such as cancer and tumors (i.e., non-thermal ablation methods), blood clots, fibroids, cysts, organs, scar and fibrotic tissue removal, or other tissue destruction and removal. Electrode assembly and catheter designs could also be used for neurostimulation treatments, targeted drug delivery, treatments of tumors in body lumens (e.g., tumors in blood vessels, the esophagus, intestines, stomach, or vagina), wound treatment, non-surgical removal and destruction of tissue, or used in place of thermal treatments or cauterization for venous insufficiency and fallopian ligation (i.e., for permanent female contraception).

In one or more examples, the electrode assemblies and catheters described herein could also be used for tissue engineering methods, for instance, for mechanical tissue decellularization to create a bioactive scaffold in which new cells (e.g., exogenous or endogenous cells) can replace the old cells; introducing porosity to a site to improve cellular retention, cellular infiltration/migration, and diffusion of nutrients and signaling molecules to promote angiogenesis, cellular proliferation, and tissue regeneration similar to cell replacement therapy. Such tissue engineering methods may be useful for treating ischemic heart disease, fibrotic liver, fibrotic bowel, and traumatic spinal cord injury (SCI). For instance, for the treatment of spinal cord injury, the devices and assemblies described herein could facilitate the removal of scarred spinal cord tissue, which acts like a barrier for neuronal reconnection, before the injection of an anti-inflammatory hydrogel loaded with lentivirus to genetically engineer the spinal cord neurons to regenerate.

In some embodiments, an IVL catheter is a so-called “rapid exchange-type” (“Rx”) catheter provided with an opening portion through which a guide wire is guided (e.g., through a middle portion of a central tube in a longitudinal direction). In other embodiments, an IVL catheter may be an “over-the-wire-type” (“OTW”) catheter in which a guide wire lumen is formed throughout the overall length of the catheter, and a guide wire is guided through the proximal end of a hub.

It should be noted that the elements and features of the example catheters illustrated throughout this specification and drawings may be rearranged, recombined, and modified without departing from the present invention. For instance, while this specification and drawings describe and illustrate catheters having several example emitter assembly designs, the present disclosure is intended to include catheters having a variety of emitter assembly configurations. The number, placement, and spacing of the electrode pairs of the shock wave generators can be modified without departing from the subject invention. Further, the number, placement, and spacing of enclosures of catheters can be modified without departing from the subject invention.

It should be understood that the foregoing is only illustrative, and that various modifications, alterations and combinations can be made by those skilled in the art without departing from the scope and spirit of the disclosure. Any of the variations of the various catheters disclosed herein can include features described by any other catheters or combination of catheters herein. Furthermore, any of the methods can be used with any of the catheters disclosed. Accordingly, it is not intended that the systems, catheters, and methods described herein be limited, except as by the appended claims.